Entresto -- your experience

My EF went from <10% to 50–55% in about 15 months with Entresto, Metoprolol Succinate and Farxiga. My copay for a 90-day supply of Entresto is $75 but Entresto's co-pay savings program reduces that to only $10 per 90 days.

Novartis offers three types of assistance:

1. Everyone is eligible for a one-time free 30-day supply of Entresto

2. People with commercial insurance (employer-provided and marketplace plans) are eligible for a co-pay assistance card which will reduce co-pay/co-insurance to as little as $10 per fill (up to a maximum $3250 per year including the free 30-days, if you use that)

3. People without prescription coverage can apply for assistance through the Novartis patient assistance program (I assume income limits apply but don't know the details)

Information on all of this is available at https://enspiresupport.entresto.com/.

You may want to look for a health insurance plan on healthcare.gov. You may find the tax credit covers much or all of your premium but even without the tax credit, it could be cheaper than paying for the drugs. Having commercial insurance lets you take advantage of co-pay programs that reduce high co-pays for many brand name drugs.

The key is to find a plan that doesn't require a deductible for prescription drugs and then use the co-pay programs. Just as a total random example, in Houston, Oscar offers the "Oscar Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers)" plan for $498.47 for a 50yo no-smoking man. The co-pay for Entresto is $187 for a 30-day supply but with Entresto's co-pay card, that is reduced to $10 for a total cost of $508.47 compared to $631.72/month for Entresto with the lowest GoodRX price in Houston.

If you end up needing to take other brand name drugs for heart failure*, the advantage of insurance+co-pay card quickly add up. For instance, Farxiga would cost $537.24 with GoodRX but with the above marketplace plan, the copay would be $187/30 days. The Farxiga co-pay card would reduce that by $150/30days so the cost would be only $37. So now you're getting Entresot+Farxiga for $545.47/month versus $1198.96 with GoodRX. If our hypothetical 50yo man in Houston had a spouse and annual household income of $70,000, he would be eligible for a tax credit of approximately $149/month, which would take the monthly cost down to $396.47.

*The latest guidelines for treatment of HF with reduced EF call for quadruple therapy plus diuretics as needed. Quadruple therapy consists of:

1. Beta-blockers (carvedilol, metoprolol succinate, or bisoprolol)

2. ARNi (Entresto) though in some cases an ACEi or ARB may be acceptable/preferable

3. SGLT2i (Farxiga or Jardiance)

4. MRA (spironolactone or eplerenone)

No prescription coverage? I pay $75 for 90 days. That’s insane. The company that makes entresto also offers assistance with paying for it if it’s not covered or your copay is astronomical.

And I believe in it. My EF went from 15% to 51% over the course of a year. Coupled with diet change and exercise it is definitely a wonder drug.

I just wanted to to chime in that some folks will notice a drop in Blood Pressure, as i did, but do keep in mind, low BP is really only considered problematic in HF patients if it is symptomatic... my new normal is almost always below 90/50, and while that troubled me (mentally) for quite some time, my body tolerates it extremely well. So well that I almost never feel light headed at all, even when standing quickly from a squat position. It did take some getting used to, at first I would feel light headed a little after sitting inactive then quickly standing, but after about a month or so it went away. Now I will VERY rarely feel a little light head if I am (very) dehydrated.. usually it also has to be not long after awakening, and while my diuretic is near its peak activity. Now I still don't love to look at those low numbers, I seem to be completely unaffected by them... Oxygen saturation is normal, all other non-heart specific body functions are normal, even things that as a man I thought would quit working once BP dropped that low are still fine (much to my surprise!) lol.

I also have felt great improvement, and will be having my first echo after starting Entresto in about 2 months, I have been on it for about a year now. When it was started, I was in a period of decline; my exercise tolerance was declining rapidly, I had lost about 20% of my muscle mass in just a few months, I was tired most of the time, my activity levels had declined, and I became winded relatively easily... but now, I just got back on my snowboard after about a 3 year hiatus, I walk at least 5 miles a day, every day, I can even jog a short distance, I feel very good. All this after a period where I felt like death would come within a few months time. Is this entirely attributable to the Entresto, probably not, but it undoubtedly played a big part.

I also now eat healthier than ever, and specifically have reduced my sodium to consistently be under 2300mg per day and usually under 1800mg, although I find I have little or no issues there as long as I stay under 3000mg. A good low sodium breakfast for example would be some oatmeal (plain, big container from walmart) with a little Cinnamon and some bourbon maple syrup to sweeten left overnight in the fridge with some oat or coconut milk... or substitute the syrup for a little nesquik, or honey... it is quite delicious! I also make low sodium tacos that are surprisingly very healthy, using lean ground beef (80% Lean or more), and Mrs Dash Taco seasoning Mix, and hard shells (you'll have to look to find ones with lower sodium, but where I live Safeway carries several that are, Walmart does not) or use soft corn tortillas (most are low sodium, but check). There are also some hot sauces that do not add much sodium but add a bit of flavor, I really like Lola's Trinidad Scorpion hot sauce myself it is not as hot as it sounds, and has red jalapeños in it to level it out a bit. Cutting salt can be unpleasant at first, but you do get used to it, and you will find things that are delicious and low sodium. Plus you can eat a "normal" meal every once and a while... once you find that the "secret ingredient" most food is flavored with is just salt, and reduce it, you'll begin to appreciate other flavors you never really tasted in full.

Other things I avoid besides salt are Trans fats, there's some in beef, but other than that (which I still do not eat in abundance) I pretty much avoid anything that isn't 0 trans fat in the nutrition information. I also avoid saturated fats where I can, but do not worry too much about it. If you're looking for the fatty kind of savory though, do indulge in monounsaturated fats, and don't worry about polyunsaturated... they both help reduce inflammation, cholesterol, and improve overall health! I also try not to consume excessive carbs, not counting fiber of course, which I consume in abundance. I do not do anything crazy like Keto, and I suspect that it (and other fad diets) might actually be harmful to a heart patient. In addition, I watch my total calorie intake. I have found an app called MyFitnessPal to be helpful for tracking food, and a smart watch for tracking activity. I also keep cholesterol consumption under 300mg, and usually under 150, although I will go over 300 to have some eggs every once in a while... cholesterol is not just 1 chemical, neither are any 1 of the fats, and research has shown that cholesterol from eggs does not contribute to blood cholesterol as much as most other things.

A little background on me for reference: I am a 37 year old Male, 6'3, about 240lbs (and dropping!), I have been fighting Heart Failure for about 10 years, having recovered from an EF of 15 to over 50, then slacked off and ate poorly, for several years, declined to below 30, but am now enjoying (and I do mean enjoying) a healthier lifestyle again and am grateful for my extra time here, I should have been dead at least twice. I have also had arrhythmias, including persistent aFib, a flutter, have had several cardiac ablations and a fee electrical cardioversions. I have an implanted CRT-D device (cardiac Resynchronization pacemaker with defibrillator function) and am only paced less than 5% by it now that I am out of aFib. Contributing to my heart failure, likely its biggest contributer, has been SEVERE sleep apnea, which is still proving difficult, but i am having mildly more success treating, weight loss is helping with that. I hike, snowboard, climb a little, mostly just boulders (after many years of not), and do almost every thing a "normal" man my age would do.

Medications I'm on currently by Rx or Dr's requirement: aspirin, carvedilol, Eliquis, Entresto, Farxiga, Fexofenadine, Fluticasone, Magnesium, Melatonin, potassium, spironolactone, Torsemide.

Supplements I'm on currently, recommend by nutritionist and checked with my Drs: calcium with vitamin D, CoQ10, Fish Oil/Omega-3, Magnesium, Probiotic.

My last decline was so bad that, much like my first, it put me out of work. I am an electrician, and my job can be extremely physical at times. With my recent improvements however, I will be returning to work in a month or so. I will undoubtedly need to retire early or face further decline, and I don't know for how long I'll be able to work. It also is highly likely I will require an LVAD or a heart transplant within the next 10 years or so I choose to keep fighting this at that point. I have a son who will be 18 around then, so I think I will do what is necessary to stick around for him.

Do remember that whatever you do, dealing with heart failure is a marathon, not a sprint. You do not have to fight it super hard just a little every day, and even junk food and lazy days are OK in moderation, but an overall healthy lifestyle is essential, not just to live longer, but to maximize quality of life, since it will alow you to do more... I think there's a lot more to this whole living thing than just trips around the sun. Best of luck!

There is a coupon I got through the manufacturer that I pay $10 for 60 pills (97/103) so go through their website.

Only buy one month at a time in case you can’t tolerate it. My husband had to stop.

My initial price was in the thousands as well, but like others have said, I got the $10 co-pay card. My ef went from low 20s(where it had been for a few years) to high 30s. No other medication change, just Entresto.

3 years ago I survived a widow maker. Started 2 years ago and I have been of 7 road-trips and 12 cruises including flights to Europe and Australia from the US. Magic in pill form.

My dad has been on it for cardio myopathy heart failure and it has slightly improved his ejection fraction from 15% to 25% over the period of 5 months. He is also taking other meds as well. So I’m not positive it was the entresto.

Definitely go to manufacturers website. They have $10/month deal as long as you have insurance. It has worked for me.

I'm still new at this. But I didn't get that medicine from the doctor. What is it and should I ask my doctor about it?

Worked for me as well. No side effects and ef went down. I think I’m on the higher dose now but started low.

It's less than half that price in Canada without any drug plan. Anyways, yeah I'm pretty stable on it, farxiga and bisoprolol

In September my ejection fraction rate was at 20 percent. Went for my 3 month check up last week and it’s up to 55 percent. I’m on the highest does. I printed out coupons from their websites and so far I’ve paid no more than 10 bucks

It has helped my dad a lot. His blood pressure kept getting higher and higher on the Lisinopril he was on, so he switched to Entresto. His blood presssure has been fine for months now. It's been so good, though, that my dad is still on the lowest dose.

It helped me and took me out of heart failure. I was on 24/26 but when they tried to raise it side effects were too much. A year ago my heart doc decided to raise again and my insomnia is back and I'm not feeling like my kidneys are messed up. Been on it almost 10 years.

My advice is pay attention to your body and if side effects get too great, talk to your Dr I see him 16th . I'm on 49/51 AM and low dose PM

Oh and in carvedilol too. Which isn't easy on the body.

Lyme Disease caused all my issues and I caught the heart failure bcz I had cancer in my thyroid and had to wait until my heart was stable. Oct 2020 was told I was out of HF but the next month we had Covid severely.

I have anxiety and white coat syndrome so first bp reading is high then it drops normal.

I wish he'd never insisted I raise my dosage a year ago.